As noted here earlier, a major theme of the July/August issue of the Washington Monthly is the heavy hand of medical specialists in the U.S. health care system, at the expense of the primary care services that are the key to universal health care and to reducing long-term costs. Phillip Longman wrote about the role of publicly subsidized teaching hospitals in encouraging over-specialization, and Haley Sweetland Edwards revealed the mysteries of a Medicare price-setting arrangement dominated by specialists’ associations.

But how does the system look from the perspective of a primary care physician? Dr. Candice Chen, a pediatrician at a primary care clinic in the underserved southeast Washington, DC community (and also a health policy research professor at George Washington University) gives us a look at a day in her harried life in the July/August issue of the Monthly. And she explains why it matters that primary care clinics are in relative terms poorly compensated for their critical work:

Primary care services are generally compensated less than other specialties, so even when a primary care doctor can see more patients, he or she still can’t earn as much as, say, a cardiologist or a surgeon. Primary care doctors make one-third the average income of orthopedic surgeons, according to the Medical Group Management Association. But a bigger problem is that this payment difference means primary care practices can’t hire the additional staff or make the investments that will allow doctors to focus on doctoring and not on the million little administrative tasks that come along with providing health care.

Chen describes her day as a race between appointments, often begun late with apologies to patients. Primary care shortages and the need for volume to make ends meet are largely to blame, but also illustrate the vicious cycle that leads so many health professionals to look to specialties for a career–at everyone’s expense.

Ed Kilgore

Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.